Knee Pain

The knee and its function.

The knee is a joint with three parts:

The thigh bone (femur) meets the large shin bone (tibia) forming the main knee joint. This joint has 2 compartments : an inner (medial) and an outer (lateral). The kneecap (patella) joins the femur to form a third joint, called the patellofemoral joint.
The knee joint is surrounded by a capsule and ligaments strapping the inside and outside of the joint (collateral ligaments) as well as crossing within the joint (cruciate ligaments). These ligaments provide stability and strength to the knee joint.
The meniscus is a thickened cartilage pad between the two joints formed by the femur and tibia. The meniscus acts as a smooth surface for the joint to move on. The knee joint is surrounded by fluid-filled sacs called bursae, which serve as gliding surfaces that reduce friction of the tendons. Below the kneecap, there is a large tendon (patellar tendon) which attaches to the front of the tibia bone. There are large blood vessels passing through the area behind the knee (referred to as the popliteal space). The large muscles of the thigh move the knee. In the front of the thigh, the quadriceps muscles extend the knee joint. In the back of the thigh, the hamstring muscles flex the knee. The knee also rotates slightly under guidance of specific muscles of the thigh.

The knee functions to allow movement of the leg and is critical to normal walking. The knee flexes normally to a maximum of 120 degrees and extends to 0 degrees. The bursae, or fluid-filled sacs, serve as gliding surfaces for the tendons to reduce the force of friction as these tendons move. The knee is a weight-bearing joint. Each meniscus serves to evenly load the surface during weight-bearing and also aids in disbursing joint fluid for joint lubrication.

Knee Pain

Knee pain can be caused by injury, degeneration, arthritis and, rarely, by bone infections or tumors. The knee joint is the most commonly involved joint in rheumatic auto immune diseases that affect various tissues of the body including the joints to cause arthritis.
Ligaments within the knee (cruciate ligaments) and on the inner and outer sides of the knee (collateral ligaments) can be sprained or torn.
Surgical repair of ligament injury can involve suturing, grafting, and synthetic graft repair. Routine x-rays do not reveal ligament or meniscus tears, but can be used to exclude other problems of the bones and other tissues.

Injury and Symptoms

Injury can affect any of the ligaments, bursae, or tendons surrounding the knee joint. Injury can also affect the ligaments, cartilage, menisci (plural for meniscus), and bones forming the joint. The design of the knee joint and that it is an active weight-bearing joint are factors in making the knee one of the most injured joints of the human body.

Knee Diseases and Conditions

Diseases or conditions that involve the knee joint, the soft tissues and bones surrounding the knee, or the nerves that supply sensation to the knee area can result in knee pain. In fact, the knee joint is the most commonly affected joint in rheumatic diseases, immune diseases that involve various tissues of the body including the joints to cause arthritis.

Arthritis is an inflammation within a joint. The causes of knee joint inflammation range from types of arthritis such as osteoarthritis, which is a degeneration, or wear and tear of the cartilages, to inflammatory types of arthritis (such as rheumatoid arthritis or gout).

Baker cyst is another common cause of pain at the back of the knee resulting from swelling of the knee joint from arthritis leading to a localized collection of fluid accumulating in a cyst behind the knee.

Tumors and Infections of the bone or joint can rarely be a serious cause of knee pain and have associated signs of infection including fever, extreme heat, warmth of the joint, chills of the body, and may be associated with puncture wounds in the area around the knee.

Pellegrini-Stieda syndrome is a calcification of the collateral ligament on the inside of the knee joint. With this condition, the knee can become inflamed and can be treated conservatively with ice packs, immobilization, and rest. Infrequently, it requires a local injection of corticosteroids.

Chondromalacia refers to a softening of the cartilage under the kneecap (patella). It is a common cause of deep knee pain and stiffness in young women and can be associated with pain and stiffness after prolonged sitting or climbing stairs. Treatment with anti-inflammatory medications, ice packs, rest and massage may help.

Jumper’s Knee (Patellar tendonitis)

Jumper’s knee, also known as Patellar Tendonitis, is a condition caused by inflammation of the Patellar tendon, which connects the kneecap to the shin bone (Tibia). The condition is caused by overuse of the knee joint, for example – by frequent jumping onto a hard surface.

Symptoms of jumper’s knee
The symptoms of jumper’s knee may vary significantly among individuals. The symptoms may include:
Tenderness and pain around the Patellar tendon
Swelling
Pain with jumping, running, or walking or any leg movement.
Bending or straightening the leg will be painful.
Tenderness behind the kneecap
Diagnosis of Jumper’s knee
The diagnosis of jumper’s knee is usually based on a complete medical history and physical examination. Sometimes the x-rays are performed.

Treatment for jumper’s knee:
The treatment of choice for jumper’s knee is an avoidance of any activity that may cause or aggravating the condition until the injury is healed. Other treatment modalities may include:

Anti-inflammatory medications
Rest
Ice pack application.
Massage Therapy is very successful and effective in reduction of swelling and promotion of healing.
Stretching and strengthening exercises.

Other common knee problems
Many knee problems are can result from continual wear and tear and continued stress on the knee joint; other knee problems result from an injury or a sudden jolt or movement that strains the knee.

Common knee problems include the following:
Sprained or strained knee ligaments
Ligaments connect one bone to another within the joins and contribute stability and flexibility of the joint.

Medial Collateral Ligament (MCL).
This ligament is on the one on the inside of the knee and is taut when the leg is straight. The ligament itself is strong but can be sprained or completely ruptured by simultaneous twisting and straightening of the leg.

Anterior Cruciate Ligament (ACL).
The anterior cruciate ligament or ACL runs from the outside of the back of the thigh bone to the inside of the front or anterior of the shin bone. The two cruciate ligaments cross over each other; the ACL crosses in front of the Posterior Cruciate Ligament. Together they stabilize the front to back movements of the knee.
The ACL is half the strength of your Medial Collateral Ligament (MCL). This ligament is the most likely knee ligament to be injured during sporting activities.

Posterior Cruciate Ligament (PCL).
The Posterior Cruciate Ligament or PCL starts from the inside edge of your thigh bone and inserts to the back or posterior aspect of your shin bone.

Lateral Collateral Ligament (LCL).
The Lateral Collateral Ligament or LCL runs from the bottom of the thigh bone to the top of the shin bone on the outside of knee joint.
Sprained or strained muscles. A sprained or strained knee ligament or muscle is usually caused by a violent blow to the knee, or a sudden twist of the knee. Symptoms include pain, swelling, and difficulty in using the leg while walking.
Torn cartilage Trauma to the knee may tear the Menisci (the pads of connective tissue that act as shock absorbers and aid in joint stability). Cartilage tears will often occur with sprains. The wearing of a brace during an activity may protect the knee from further injury.

Tendonitis.

Inflammation of the tendons can result from overuse of a tendon during sporting activities such as running and general athletics. Tendonitis of the Patellar tendon is called Jumper’s knee.
Arthritis Osteoarthritis is generally the most common type of arthritis that affects the knee. Osteoarthritis is a degenerative process where the cartilage in the joint gradually wears away, Osteoarthritis may be caused by excessive stress on the joint. Rheumatoid arthritis can also affect the knees by causing the joint to become inflamed and by destroying the knee cartilage.
Knee bursitis Carpet fitters and other people who spend a lot of time on their knees often experience swelling in the front of the knee. The constant friction irritates the lubricating sac (Bursa) located just in front of the kneecap (Patella). The Bursa enables the kneecap to move smoothly under the skin. If the Bursa becomes inflamed, it fills with fluid and causes swelling at the top of the knee. This condition is known as kneecap (Prepatellar) Bursitis.

Symptoms:
Pain with leg activity.
Swelling on the front of kneecap.
Tender and warm to the touch.

Treatment:
Apply ice regularly, 8 times a day for 15 minutes at a time. This should reduce swelling considerably if the knee is also rested.
Elevate the affected leg as much as possible.
Take an anti-inflammatory medication such as aspirin or ibuprofen.
Massage Therapy.

Goosefoot (Pes Anserine) Bursitis of the Knee

Pain and tenderness on the inside of the knee, approximately 2 to 3 inches below the joint, are symptoms of Pes Anserine Bursitis of the knee. The Pes Anserine Bursa is a lubricating sac located between the shinbone (tibia) and three tendons of the hamstrings muscle insertion at the inside of the knee. Because the three tendons flare out on the front of the shinbone and look like the foot of a goose, Pes Anserine Bursitis is also known as Goosefoot Bursitis.

Risk factors
Pes Anserine Bursitis is common in athletes, especially runners. Several factors can contribute to the development of Pes Anserine Bursitis, including:

The symptoms of Pes Anserine Bursitis:
Slow developing pain on the inside of the knee in the centre of the shinbone, approximately 2 to 3 inches below the knee joint.
Increased pain with exercise.
Symptoms may appear to be those of a stress fracture, so an X-ray is usually required.

Treatment:
Discontinue all vigorous activity until the Bursitis clears up.
Injection – Your doctor may inject a solution of anesthetic and steroid into the bursa, which often provides prompt pain relief.
Anti-inflammatory medication – nonsteroids may ease the pain and reduce inflammation.
Ice application at regular intervals throughout the day, 8 times daily, for about 15 minutes each time.
MassageTherapy should be used if you require an Effective and fast Treatment.

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